December 15, 2008

Welcome to the Harvard Health Publications e-Newsletter.

This e-Newsletter is one in a series of monthly e-Newsletters. Each issue will bring you valuable information on various topics — news you can use to live a healthier, happier, and more fulfilling life. We hope you enjoy this and all of the issues to come.

In this issue:
+ The value of regret
+ Stress and cholesterol
+ Core conditioning: It's not just about abs
+ Low-carb dieting: Slimmer but sadder?

The value of regret

Regret is a powerful and potentially devastating emotion.

In 1995, a Liverpool man who regularly played one set of lottery numbers failed to renew his ticket during the week his numbers came in. Thinking (wrongly as it turned out) that he’d let a prize worth millions slip away, he committed suicide.

We can’t know what he was thinking, but we can imagine that his emotional distress was compounded because he felt personally responsible for the outcome. And that is one definition of regret: recognizing the difference between how things are and how they might have turned out — if only we had made a different choice.

Since the late 1990s, the study of regret has benefited from the availability of advanced neuroimaging techniques. We have evidence that parts of the brain responsible for reasoning and emotion become active when a person experiences regret. In particular, an area known as the orbitofrontal cortex (OFC), located in a region of the brain responsible for reasoning, may carry out the essential task of comparing real outcomes with imagined alternatives. Brain scans demonstrate increased OFC activity when people experience regret. And patients who have suffered injuries to that part of the brain are unable to experience or learn from regret.

Much of the literature on regret discusses its negative impact. It’s considered stressful and may lead to physical illness. It may be amplified by depression, or it may be a cause of depression. Exaggerated feelings of regret are associated with a poorer quality of life in later years. If one fails to learn from experiences of regret, the outcome may be misery, self-destructive behavior, or — as in the Liverpool case — a fatal act.

But a study highlights the benefits of regret. Colleen Saffrey at the University of Victoria and colleagues at the University of Illinois, writing in the journal Motivation and Emotion, provide evidence that people actually have a high regard for regret.

In one study, subjects rated regret favorably in a survey, indicating that experiencing this emotion helped them make sense of life events and come up with a remedy for what went wrong. In a second study, the researchers asked subjects to reflect on 11 negative emotions — such as fear, anger, anxiety, and shame — in addition to regret. The subjects rated how much they agreed with statements about the value of the emotions, for example, whether an emotion “helps me know how to act in the future” or “improves my relationships with others.” Across the board, regret was the most highly valued of the negative emotions studied.

Regret has an important social context, too. We learn not only from our own mistakes, but from the mistakes of others. We also learn about preferable outcomes by seeing our peers, colleagues, or neighbors make favorable or unfavorable choices. This may engender envy or relief, but — either way — it helps us figure out how to improve our lot.

The literature is persuasive on the importance of regret in decision making. The power of regret may explain why few of us are very good at objectively appraising risks and benefits. Rather than looking forward to figure out what is in our best interests, we typically look backward. We reflect on what has and has not worked out in the past. Then, whether we are deciding about a life partner, a career, a financial investment, or a medical treatment, we choose the option we are least likely to regret.

Managing regret productively may be an essential ingredient for mental health, a good quality of life, and a positive sense of well-being. If that’s true, it is worth continuing to make it a focus of research and therapy.

Harvard Mental Health Letter

Volume 25 – Number 1 – July 2008

Stress and cholesterol

The body’s metabolism is complex — and despite major scientific advances, its fine print is still a bit hard to read. That’s true even for a molecule as important as cholesterol. Researchers have learned that a man’s blood cholesterol profile results from the interplay of many influences, including genetics, hormones, diet, body fat, exercise, and exposure to alcohol, tobacco, supplements, and medication. And a study from England suggests that this formidable list should be expanded further by adding stress.

A stressful study

The subjects were 106 male and 93 female British civil servants between the ages of 45 and 59. None had coronary artery disease or hypertension, and none was taking drugs for cholesterol or blood pressure. At the beginning of the study, each volunteer was weighed and measured, and each filled out a medical questionnaire. After blood samples were obtained, each subject was asked to perform a series of mentally stressful tasks while being monitored to evaluate their psychological and chemical responses. A final blood sample was obtained at the end of each experimental session.

Although there was considerable variation among the subjects, stress did produce an increase in blood cholesterol levels. On average, the total cholesterol rose about 7 mililgrams per deciliter (mg/dl) — the LDL (“bad”) cholesterol by 5 mg/dl, and the HDL (“good”) cholesterol by 1.6 mg/dl.

The increase in LDL cholesterol seems small, but if sustained, it would increase a person’s heart attack risk by about 3%. But the rise in cholesterol occurred over a brief exposure to stress, and the scientists did not monitor blood tests later in the day to see if the levels stayed up. However, they did come back for a second look — three years later.

Second opinions

In terms of cholesterol, the passage of three years took more of a toll than a morning of experimental stress: Over three years, the volunteers’ average cholesterol levels rose from 209 to 225 mg/dl, and the LDL cholesterol rose from 123 to 139 mg/dl. Changes in health habits did not account for the rise, but body weight did play a role; the people who gained the most weight experienced the greatest rise in their cholesterol levels. That was certainly expected. More surprising was the observation that the people whose cholesterol levels rose the most in response to stress also experienced the greatest three-year increases, even after body weight and other variables were taken into account.

Explanations and implications

The British experiment did not explore how stress affects cholesterol levels, but several possibilities come to mind. Stress activates the sympathetic nervous system and pumps stress hormones such as adrenaline and cortisol into the blood. Among other functions, the stress hormones act to mobilize the body’s energy reserves. That means they liberate sugar from the liver and fatty acids from adipose tissue. These hormones also appear to boost the liver’s production of low-density lipoproteins, which transport “bad” cholesterol in the blood.

The study showed that relatively mild mental stress can produce a relatively small rise in blood cholesterol levels. Unfortunately, the researchers did not learn how long the increase persisted. More research is needed, both to confirm the observation and to see if the stress-induced changes last long enough to be medically important.

The follow-up results are also interesting. Life is filled with stress. The people who responded to mild mental stress with the largest increase in blood cholesterol levels also showed the largest rise over the next three years. Weight gain and lifestyle changes did not explain this association. Perhaps, then, it is due to the cumulative effects of daily stress.

The metabolism is complex, and it will take time to sort out this latest wrinkle. Until scientists complete their work, you should do everything you can to help lower your cholesterol: eat right, get enough exercise, stay lean, avoid tobacco, don’t abuse alcohol — and relax.

Harvard Men’s Health Watch

Volume 11 – Number 7 – February 2007

Core conditioning: It’s not just about abs

Many of us have wished for flatter stomachs, a goal that seems more frustrating and elusive the older we get. You might have been tempted by infomercials for exercise devices or breathless magazine articles promising “flat abs” and tighter tummies “in just days.” Despite the hype, spot exercising abdominal muscles won’t get rid of fat. The only way to do that is to expend more calories than you take in. Working these muscles has its place, but the smart money these days is on strengthening a variety of trunk muscles, collectively known as “the core.”

Core conditioning improves posture, which contributes to a trimmer appearance (poor posture can give even a woman with well-toned abs a little “pot”). Moreover, developing core muscle strength can boost the effectiveness of workouts and reduce the risk of injuries that sideline our efforts to stay in shape.

Getting at the core

If you’ve ever had physical therapy to treat low back pain, you’re probably familiar with the concept of strengthening the core — the muscles in the abdomen, lower back, and pelvis that lie roughly between the rib cage and the hips. The strength and coordination of these muscles is important not only for sports and fitness routines but also for daily life — for example, reaching up to a shelf, lifting a child, or sponging a spot off the floor.

The current drive behind core conditioning comes in part from studies conducted in the 1990s showing that before they move an arm or leg, people with healthy backs (in contrast with those suffering from low back pain) automatically contract their core muscles, especially the transverse abdominal muscles, which wrap from the sides of the lower back around to the front. Experts concluded that well-coordinated core muscle use stabilizes the spine and helps create a firm base of support for virtually all movement. The role of the core is also central to the Pilates method, a series of exercises developed during World War I to help rehabilitate soldiers returning from the war. Its founder, Joseph Pilates, referred to the core as the “powerhouse.”

These days, patients who are receiving physical therapy for chronic low back pain or injury are told to contract their core muscles before performing prescribed exercises. And Pilates exercises are increasingly incorporated into health club workouts, along with other approaches that engage the core, such as fitness (stability) balls, yoga, and tai chi.

Exercises that strengthen abdominal and other core muscles should be part of an overall fitness plan that includes regular moderate-intensity aerobic exercise, such as brisk walking, 30 minutes per day, most days of the week. Guidelines also encourage us to get 20 to 30 minutes of strength training two to three times a week, and that might be a good time to fit in a few exercises designed to work the core.

Selected resources

American College of Sports Medicine

American Council on Exercise
“Health and Fitness Information”

Sample exercises

To be safe and effective, core muscle strengthening exercises require proper alignment and progression from one type of exercise to another — adjusted to your body and fitness level. So you may want to ask a physical therapist or exercise professional for help in planning a program for you. (If you haven’t been physically active or have back problems or some other medical condition, consult a clinician before embarking on any fitness program.)

You’ll probably start by learning how to “draw in” — the first step in performing all core exercises and a basic tool you can use in almost any physical activity you perform (including walking). Here’s what you do: Sitting, standing, or lying on your back, gently but firmly tighten the abdominal muscles, drawing the navel in toward the small of the back. The tailbone should be slightly tucked. (Some trainers prefer to call it “bracing” the muscles, as if you were preparing to take a punch in the stomach.) Practice holding this position for 10 seconds at a time while breathing normally (that’s the hard part!). Once you get the hang of drawing in, you can start doing some core exercises, progressing from those you do on a stable surface (the floor or a mat) to those performed on an unstable surface, like a stability ball.

Below are just a few exercises that can help strengthen core muscles. If you decide to try any of them, go slowly, work at your own pace, and don’t keep doing anything that causes pain. Concentrate on performing the exercises correctly, not on the number of repetitions or how quickly you can do them. And don’t forget to breathe!

Basic crunch

Lie on your back with your knees bent and feet flat on the floor. Place your fingertips at the back of your head. Tighten your abdominal muscles; then curl your upper body forward, lifting your shoulder blades off the floor. Hold for one or two seconds. Slowly lower halfway to the floor; then repeat. Work up to 12 to 16 crunches. Note: Don’t speed through the crunches!

Reverse crunch

Lie with your back pressed to the ground, your hands at your sides, your knees bent, and your feet off the floor (ankles crossed) so that your knees create a 90-degree angle. Tighten your abdominal muscles, and raise your hips toward your rib cage, curling your tailbone off the floor (see illustration). Hold for a second or two; then slowly lower your hips to the starting position. Work up to 12 to 16 repetitions. Note: Use your hands at first to help stabilize yourself, but rely on them less as you get stronger.


Lie stomach-down on a mat, resting on your forearms (like a sphinx). Tighten your abdominal muscles, and press up so you’re balanced on your toes and elbows (see illustration). Don’t let your hips sag or stick up: your body should be in a straight line from head to heels. Hold for 20 to 30 seconds; then lower and repeat a few more times. Work up to holding the plank position for 60 seconds.

Arm and leg raise

Lie on your stomach with your arms above your head. Tighten your stomach muscles; then lift your right arm and left leg (see illustration). Hold for five seconds. Lower, and rest a moment; then repeat with the left arm and right leg. Work toward eight to 12 repetitions on each side. Note: Avoid arching your back (keep your abdominal muscles engaged and your pelvis tucked). When you’re ready for more, try lifting the leg and arm on the same side.


Lie flat on the floor on your back. Place your fingertips at the back of your head. Tighten your abdominal muscles, bring your knees up to a 45-degree angle, and lift your shoulder blades off the ground. Turn your upper body to the left, bringing the right elbow toward the left knee and extending your right leg (see illustration). Switch sides, bringing the left elbow toward the right knee. Continue this pedaling motion, slowly, for a total of 12 to 16 repetitions. Rest and repeat. Note: Avoid pulling on the neck.

Stability balls

Because the ball is intrinsically unstable, core muscle activity is greater when you perform certain exercises on it (a crunch, for example) than when you perform the same exercises on a stable surface. Stability balls come in various sizes (35 to 85 centimeters — 14 to 34 inches — in diameter). Check the label on the box to find the correct size for your height. Start by sitting upright on the ball with your feet flat on the floor. To get a feel for remaining balanced, move your hips from side to side, then in circles.

Arm and leg raise on the ball

Lie over the ball so that your hips are on top of it and your legs are straight. Toes and fingers should comfortably reach the floor. Tighten your stomach muscles, then lift your right arm and left leg (see illustration). Hold for five seconds; rest a moment; then repeat with the left arm and right leg. Do eight to 12 repetitions. When you’re ready for more, try lifting the same leg and arm.

Exercise ball crunch

Sit on the ball with your feet flat on the floor, hip-width apart. Let the ball roll back slowly until your thighs and hips are parallel to the floor (you may need to walk your feet out a bit) and the ball is at your lower back. Place your fingertips at the back of your head. Keeping your lower body still, contract your abdominal muscles and curl your upper body forward, lifting your shoulder blades off the ball (see illustration). Hold for a second or two; then lower your upper back. Repeat a total of 12 to 16 times. Note: When you’re ready for more, move your feet closer together. Exhale as you contract; inhale as you return to the starting position.

Harvard Women’s Health Watch

Volume 16 – Number 2 – October 2008

Low-carb dieting: Slimmer but sadder?

Low-carb diets have done well in some head-to-head comparisons with other diets. And no matter what the diet, shedding a few pounds usually makes people happy.

But there’s some research suggesting that Atkins-like diets (low in carbs, high in fat and protein) could make people’s moods a little darker even if their bodies end up a little lighter. Carbohydrates promote the synthesis of serotonin, a neurotransmitter that seems to play a significant role in mood control. Some evidence suggests that avoiding carbs — and gorging on fat and protein instead — could reduce serotonin concentrations, giving some folks a case of the low-carb blues. And when diets have been tested for a short time (three weeks) in physically active people without a weight problem, low-carb eating has led to more fatigue and bad moods than high-carb eating.

Of course, those aren’t the kind of people who typically set out to lose weight. So Australian researchers set out to see what sort of influence the diets would have on mood in people more inclined to do so. Their study randomly assigned 93 people who were overweight or obese (an average body mass index of 33.6) to either a low- or high-carb eating plan.

At the end of the two-month study, the low-carb dieters had lost a bit more weight (17 pounds vs. 14 pounds), and a battery of standardized tests didn’t find a negative influence on their mood. In fact, the outlook of both the low- and high-carb dieters improved equally.

There’s a catch, though: the low-carb dieters, on average, lagged behind the high-carb dieters in a test designed to measure the speed of mental processing.

Harvard Health Letter

Volume 33 – Number 3 – January 2008

Harvard Health Publications e-Newsletter is published monthly by the Harvard Health Publications division of the Harvard Medical School. Copyright © 2008 by the President and Fellows of Harvard College. All rights reserved. 

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Medical Disclaimer

Harvard Health Publications
Editor in Chief: Anthony L. Komaroff, M.D.
Publishing Director: Edward H. Coburn

Harvard Health Letter: Anthony L. Komaroff, M.D., Peter Wehrwein
Harvard Heart Letter: Thomas H. Lee, M.D., P.J. Skerrett
Harvard Men’s Health Watch: Harvey B. Simon, M.D.
Harvard Mental Health Letter: Michael C. Miller, M.D., Ann MacDonald
Harvard Women’s Health Watch: Celeste Robb-Nicholson, M.D., Carolyn Schatz

All editorial board members of Harvard Health Publications are faculty members of Harvard Medical School and doctors at its affiliated hospitals.

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